Advertisement

Subpectoral Biceps Tenodesis With Interference Screw Fixation

      Abstract

      The proximal portion of the long head of the biceps is a recognized cause of anterior shoulder pain. This article presents a novel technique for tenodesing the proximal biceps tendon. The tendon is evaluated and tenodesed in the same anatomic position beneath the pectoralis tendon, and is removed entirely from the bicipital groove. The proximal portion of the long head of the biceps tendon is marked near its origin and lysed arthroscopically. The skin incision for the subpectoral open biceps tenodesis is made in the axilla exposing the inferior border of the pectoralis major muscle. The tendon is withdrawn from the joint and out of the incision. A Krackow or other type of interrupted tendon whipstitch is placed in the 10 to 15 mm of tendon proximal to the musculotendinous junction. A bone tunnel is created within the bicipital groove. The tendon/tenodesis driver complex is positioned to create a secure fit within the bone tunnel. Our current series includes 22 cases with short-term follow-up of 2 to 10 months. None of the repairs has pulled out and none of the patients reports persistent pain or loss of function. The subpectoral approach with interference screw fixation appears to be a promising, reproducible technique for tenodesing the biceps.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gilcreest E.L.
        Two cases of spontaneous rupture of the long head of the biceps flexor cubiti.
        Surg Clin North Am. 1926; 6: 539-554
        • Lippman R.K.
        Frozen shoulder, periarthritis, bicipital tenosynovitis.
        Arch Surg. 1943; 47: 283-296
        • Hitchcock H.H.
        • Bechtol C.O.
        Painful shoulder. Observations on the role of the tendon of the long head of the biceps brachii in its causation.
        J Bone Joint Surg Am. 1948; 30: 263-273
        • Froimson A.I.
        • Oh I.
        Kehole tenodesis of biceps origin at the shoulder.
        Clin Orthop. 1974; 112: 245-249
        • Boileau P.
        • Krishnan S.G.
        • Coste J.S.
        Arthroscopic biceps tenodesis.
        Tech Shoulder Elbow Surg. 2001; 2: 153-165
        • Edwards T.B.
        • Walch G.
        Open biceps tenodesis.
        Tech Shoulder Elbow Surg. 2003; 4: 195-198
        • Neer II, C.S.
        Impingement lesions.
        Clin Orthop. 1983; 173: 70-77
        • Cone R.O.
        • Danzig L.
        • Resnick D.
        • Goldman A.B.
        The bicipital groove.
        AJR Am J Roentgenol. 1983; 141: 781-788
        • Ahovuo J.
        The radiographic anatomy of the intertubercular groove of the humerus.
        Eur J Radiol. 1985; 2: 83
        • Read J.W.
        • Perko M.
        Shoulder ultrasound.
        J Shoulder Elbow Surg. 1998; 7: 264-271
        • Teefey S.A.
        • Middleton W.D.
        • Yamaguchi K.
        Shoulder sonography. State of the art.
        Radiol Clin North Am. 1999; 37: 767-785
        • Ahovuo K.
        • Paavollainen P.
        • Slatis P.
        Diagnostic value of sonography in lesions of the biceps tendon.
        Clin Orthop. 1986; 202: 184-188
        • Conrad M.
        • Nelms B.
        Empty biceps groove due to rupture and retraction of the biceps tendon.
        J Ultrasound Med. 1990; 9: 231-233
        • Middleton W.D.
        • Reinus W.R.
        • Totty W.G.
        US of the biceps tendon apparatus.
        Radiology. 1985; 157: 211-215
        • Connel D.A.
        • Potter H.G.
        • Wickiewicz T.L.
        Noncontrast magnetic resonance imaging of superior labral lesions. 102 cases confirmed by arthroscopic surgery.
        Am J Sports Med. 1999; 27: 208-213
        • Cyriax J.G.
        Trauma to soft tissues.
        in: Cyrizx J.G. Textbook of orthopedic medicine Diagnosis of soft tissue lesions. WB Saunders, Philadelphia1982
        • Roberts D.
        Transdermal drug delivery using iontophoresis and phonophoresis.
        Orthop Nurs. 1999; l18: 50-54
        • Walch G.
        • Nové-Josserand L.
        • Boileau P.
        • Lévigne C.
        Subluxations and dislocations of the tendon of the long head of the biceps.
        J Shoulder Elbow Surg. 1998; 7: 100-108
        • Boileau P.
        • Walch G.
        So-called “isolated” supraspinatus tears.
        in: Gazielly D. Gleyze P. Thomas T. The cuff. Elsevier, Paris1997: 320-323
        • Walch G.
        • Nové-Josserand L.
        • Boileau P.
        • Lévigne C.
        Subluxations and dislocations of the tendon of the long head of the biceps.
        J Shoulder Elbow Surg. 1998; 7: 100-108
        • Pfahler M.
        • Branner S.
        • Refior H.J.
        The role of the bicipital groove in tendinopathy of the long biceps tendon.
        J Shoulder Elbow Surg. 1999; 8: 419-424
        • Ball C.
        • Galatz L.M.
        • Yamaguchi K.
        Tenodesis or tenotomy of the biceps tendon.
        Tech Shoulder Elbow Surg. 2001; 2: 140-152
        • Mazzocca A.D.
        • Santangelo S.A.
        • Adams D.J.
        • Romeo A.A.
        • Arciero R.A.
        Mechanical evaluation of an arthroscopic interference screw, suture anchor, open subpectoral bone tunnel and subpectoral interference screw proximal biceps tenodesis techniques. 2004 (Presented at the Ninth Inernational Congress for Surgery of the Shoulder (ICSS), Washington, DC, May 2–5)